How to effectively manage palpitations?

Question

Hello doctor,

I am a 57-year-old female, and I have a question. I experience constant heart palpitations and fluttering, along with a continuous feeling of adrenaline rushing through my body. The palpitations are especially bad at night but also occur during the day when I am sitting and doing nothing. The palpitations often make me feel nauseous. On a scale of one to 10, they are about an eight. All lab results, including ECG, echo, and Holter monitor, are normal. My doctor could not figure out the cause and prescribed Propranolol 10 mg, telling me to take it once a day. Yesterday, after my doctor's visit, I had heart palpitations for four hours. I became frustrated and took one tablet. One hour later, all the palpitations and the adrenaline rush were gone. I finally slept without being woken up by palpitations, and I did not have to cough to stop them.

Two years ago, I had an angiogram due to a suspected heart attack or arrhythmia at home, as I had all the classic signs: crushing chest pain, jaw and neck pain, left arm pain, and nausea. Despite this, all laboratory tests came back normal the next day. I also had carotid artery surgery two years ago to remove a piece of plaque from my right carotid artery. No other plaque was found, and no stent was needed. Again, all my laboratory tests were normal, my cholesterol is not high, and I am on statins and Warfarin.

This must be perplexing to all my doctors because they can not figure it out. I was put on Warfarin about 15 years ago due to deep vein thromboses (DVTs) caused by previous surgery, and I have always maintained therapeutic levels. I did have a heart attack or arrhythmia a few years ago, but the angiogram came back normal, and the doctor said everything looked fine. Now, I am experiencing these persistent heart palpitations, which stop as soon as I take the beta-blocker. I have been told that while beta-blockers are anti-arrhythmic, they can also be pro-arrhythmic. Should I take the beta-blocker every day or only when I start to feel the palpitations?

Please help.

Answer 1

Hello,

Welcome to ciliniq.com.

Palpitations can be caused by cardiac arrhythmia, anxiety, psychological issues, or simply by increased awareness of one's heartbeat. Since your Holter monitor was normal during the episodes of palpitations, it rules out the possibility of a cardiac arrhythmia. Therefore, these are likely benign palpitations in your case. Propranolol is an anti-anxiety medication, and it also counters the adrenaline rush caused by psychological factors. It is not an antiarrhythmic drug per se, nor is it arrhythmogenic like other antiarrhythmics. Therefore, there is no harm in taking it regularly. It should be taken consistently for a few weeks, after which the dosage can be tapered as symptoms begin to subside. The only things to monitor are blood pressure and pulse rate, which may decrease at higher doses of propranolol.

I hope this helps, and feel free to reach out if you have any further questions.